Judicial Council of California Form SC-104, Proof of Service (Small Claims) Instructions

Enter the full legal name of the business, agency, or other entity being served.

Enter the name of the person authorized to accept service for the business or entity and that person’s job title.

Enter the court case number for this matter.

Enter the case name as it appears on the court paperwork.

Enter the date of the hearing for this case.

Enter the time the hearing is scheduled to begin.

Enter the department or courtroom number assigned to the hearing.

Enter the full name of the court and its street address for the case.

Check this box if you served a document not listed above and you will specify what that other document was.

Enter the title or name of the other document(s) that were served, if not listed above. Fill only if 'Other (specify)' is 'Yes'.

Check this box if you served Form SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court.

Check this box if you served Form SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court.

Check this box if you served an Order for examination (and select the specific examination form served below, if applicable).

Check this box if the Order for examination you served was Form SC-134. Fill only if 'Order for examination' is 'Yes'.

Check this box if the Order for examination you served was Form AT-138/EJ-125. Fill only if 'Order for examination' is 'Yes'.

Enter the full legal name of the person who is being served with the documents.

Check this box if you personally gave copies of the documents listed in item 3 to the person named in item 1.

Enter the date on which you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the time when you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Check this box if the personal service time you entered occurred in the morning (a.m.). Fill only if 'Personal Service' is 'Yes'.

Check this box if the personal service time you entered occurred in the afternoon/evening (p.m.). Fill only if 'Personal Service' is 'Yes'.

Enter the street address where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the city where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the state where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the ZIP code for the address where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the California county where the process server is registered.

Enter the registered process server’s official registration number.

Enter the name of the case (for example, the parties or case title) as it should appear on the form.

Enter the court-assigned case number for this matter.

Enter the full name of the person who served the documents.

Enter the phone number for the server.

Enter the server’s street address (including apartment or unit number, if any).

Enter the city for the server’s mailing address.

Enter the state for the server’s mailing address.

Enter the ZIP code for the server’s mailing address.

Enter the date on which the server makes and signs the declaration under penalty of perjury.

Type or print the full name of the person who served the documents.

Enter the name of the person in item 1 to whom the court papers were addressed for service by mail.

Enter the date you mailed the envelope containing the court papers.

Enter the city and state from which you mailed the envelope.

Check this box if you mailed the envelope by leaving it at an official U.S. Postal Service mail drop.

Check this box if you left the envelope at an office or business mail drop where you know the mail is picked up every day and deposited with the U.S. Postal Service.

Check this box if you asked someone else to mail the documents and you have attached that person’s completed Form SC-104A.

Enter the dollar amount charged for serving the court papers.

Check this box if you served the documents by giving them to someone other than the person in item 1 (substituted service) as described in section 4(b). Fill only if 'Order for examination (SC-134 or AT-138/EJ-125)' is 'No'.

Check this box if you left the documents with a competent adult (at least 18) at the person’s home who lives with the person in item 1. Fill only if 'Substituted Service' is 'Yes'.

Check this box if you left the documents with an adult who seemed to be in charge at the place where the person in item 1 usually works. Fill only if 'Substituted Service' is 'Yes'.

Check this box if you left the documents with an adult who seemed to be in charge where the person in item 1 usually receives mail or has a private post office box (not a U.S. Post Office box) because no known physical address exists. Fill only if 'Substituted Service' is 'Yes'.

Enter the date on which you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the time when you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Check this box if the substituted service time you entered occurred in the a.m. Fill only if 'Substituted Service' is 'Yes'.

Check this box if the substituted service time you entered occurred in the p.m. Fill only if 'Substituted Service' is 'Yes'.

Enter the street address where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the city where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the state where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the ZIP code for the address where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.